FOR THE PRESS

2 June 2009 Annals of Internal Medicine Tip Sheet

Below is information about three studies being published in the June 2 issue of Annals of Internal Medicine. The information is not intended to substitute for articles as sources of information. Annals of Internal Medicine attribution is required for all coverage. For an embargoed copy of an article, contact Angela Collom at acollom@acponline.org or 215-351-2653.

Each year, more than 182,000 American women are diagnosed with breast cancer. Mammography is the only screening method proven to reduce deaths from breast cancer. However, mammography is not always accurate. Women screened for breast cancer are often recalled for additional testing when mammogram findings are unclear. In fact, false positives account for 25 percent of U.S. mammography costs. Therefore, any intervention that can decrease mammography recall has important public health implications. Researchers studied 1,704 women between the ages of 45 and 80 who were on hormone replacement therapy and were due for an upcoming mammogram. Before their mammograms, women were randomly assigned no hormone therapy for one month, no hormone therapy for two months, or continued therapy. The women then had mammograms and answered questions about menopause symptoms. Recall rates were 12.3 percent, 9.8 percent, and 11.3 percent, respectively. Menopausal symptoms increased in the groups that stopped therapy.

Approximately 1.3 million women are physically assaulted by an intimate partner each year. Intimate partner violence, or IPV, includes threats or acts of physical or sexual violence made by one partner to another. Despite frequent health care visits, few women disclose their experience with IPV to their doctor. And for many reasons – including lack of time, discomfort with the topic, and lack of knowledge about resources – physicians seldom ask. The result is missed opportunities for intervening and preventing harm. These issues could be addressed through computer-assisted screening. Researchers randomly assigned 300 women in a busy urban clinic to either an intervention group (computerized survey on IPV) or usual care. Women in the intervention group completed a survey on a touch screen before their physician visit. The reports were then attached to the women’s medical charts. The women also received a computer-generated recommendation sheet about their reported health risks that included information on appropriate community agencies. Researchers found this method was an effective, time-efficient and patient-acceptable method to screen for and detect women at risk of IPV in a busy family medicine practice. The researchers conclude that routine use of computer screening could save time and discomfort for physicians, and provide better social and health outcomes for patients at risk for IPV. Note: This article is being released early online at www.annals.org and will be available in hard copy on July 21.

Scoring System Could Identify Asymptomatic Patients at High Risk for Diabetes

The incidence of diabetes among U.S. adults continues to increase. However, evidence shows that dietary and exercise interventions in nondiabetic adults at high risk for the disease can delay onset of type 2 diabetes – especially among those at highest risk. Simple prediction scores could help identify adults at high risk for diabetes. Using data from a prospective cohort study of 12,729 adults between the ages of 45 and 64, researchers developed and tested scoring systems that identify adults with a high 10-year incidence of diabetes. The basic system included age, weight, and waist circumference, hypertension, smoking, and family history of diabetes. The enhanced system also included blood tests. The researchers suggest that the low-cost basic approach could be used to identify asymptomatic adults who may need more thorough examination, including blood tests. The authors conclude that insurers or public health agencies may want to develop population-specific survey instruments that could serve to identify and help those at greatest need.